Provider Demographics
NPI:1093240434
Name:MARGARET MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:MARGARET MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTWIF
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-629-1300
Mailing Address - Street 1:3832 SANIE RD
Mailing Address - Street 2:STE 125
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-6941
Mailing Address - Country:US
Mailing Address - Phone:205-629-1300
Mailing Address - Fax:
Practice Address - Street 1:3832 SANIE RD
Practice Address - Street 2:STE 125
Practice Address - City:ODENVILLE
Practice Address - State:AL
Practice Address - Zip Code:35120-6941
Practice Address - Country:US
Practice Address - Phone:205-629-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH93666Medicare UPIN